Powell Valley Care Center earns five-star rating from Medicare

Posted 3/29/18

But the care center recently got more official recognition: Medicare awarded the nursing home five stars, reflecting an overall rating of “much above average.”

The rating from the federal Centers for Medicare and Medicaid Services — which …

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Powell Valley Care Center earns five-star rating from Medicare

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Over the years, staffers at Powell Valley Care Center have heard comments that the local nursing home is a cut above its peers.

But the care center recently got more official recognition: Medicare awarded the nursing home five stars, reflecting an overall rating of “much above average.”

The rating from the federal Centers for Medicare and Medicaid Services — which oversees and regulates the country’s nursing homes — is meant to serve as a “snapshot” of the quality of a facility. It draws upon a slew of data meant to capture a nursing home’s compliance with regulations, the quality of care provided to residents and the level of staffing.

While care center leaders say they’re pleased with their first five-star honor, they say nothing captures the facility like seeing it in person.

“On the one hand, the five-star rating, it’s exciting, because it is what the consumers are going to see and it is a reflection of the health inspections and the quality,” said Powell Valley Care Center Administrator Nicole Ostermiller. “But it isn’t the full picture until you actually come and you see and you’re able to talk to a resident and ask them what they like about living here; talk to the staff, talk to other families — and that probably … is the best rating.”

Medicare’s Nursing Home Compare site cautions that the ratings “can give you important information and help you compare nursing homes by topics you consider most important, but isn’t a substitute for visiting the nursing home.”

Powell Valley Care Center Nursing Director Jason Gedney echoes that advice, saying a facility could theoretically get a perfect rating while being “very institutional.”

“Just because somebody has excellent ratings, I think you should still go and check them out,” Gedney said — though, he added, “I kind of smiled when we had five stars and West Park had three and Lovell had two.”

The ratings are part of Medicare’s online Nursing Home Compare, which is intended to “help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions.”

It also creates a sense of competition — such as between the Powell Valley Care Center, Cody Regional Health (formerly West Park) Long Term Care Center and New Horizons Care Center in Lovell.

Powell Valley Healthcare trustees took some time out of their regular monthly meeting on Monday to celebrate the five-star rating — and a couple trustees made a specific point of noting West Park’s lower marks (with three stars overall, Medicare considers it to be “average”).

Powell Valley Healthcare CEO Terry Odom congratulated the care center staff on the accomplishment.

“This is really good,” she said.

“Great,” “wonderful” and “way to go” were some of the other compliments that trustees sent Ostermiller’s and Gedney’s way.

Wyoming has 37 nursing homes with ratings on Medicare’s Nursing Home Compare; 13 have earned five stars. Powell Valley Care Center is the only five-star facility in the Big Horn Basin.

Ratings rely on inspections

The current ratings are largely based on data collected between October 2016 and September 2017, with onsite inspections playing the largest role.

Inspectors not only check to see whether regulations are being followed, but observe how residents are treated and pour over policies.

For instance, Medicare staff found PVHC was following policies for reporting and investigating allegations of abuse — and has a process in place for residents and their family members to file grievances.

While that might sound straightforward, “that does not happen in the industry across the board,” Ostermiller said, adding, “I think we were pretty proud of that.”

In another point of pride, zero deficiencies were spotted in the kitchen, “which is a pretty major deal in this industry,” she said.

As another example of strong performance, the Powell Valley Care Center has ranked as one of the best in the state for its low percentage of residents on antipsychotic medications; antipsychotics are generally discouraged for elderly residents because of dangerous side effects that include an increased risk of falling.

Gedney said that, instead of using medications, care center staff try treating psychoses in other ways — such as distraction, music therapy, aroma therapy or therapeutic touch.

Antipsychotic medications are still used, in the lowest dosage possible, if that’s what a resident still needs, he said.

“Ultimately, it’s their quality of life, and we want them to have the highest quality that they can while they’re here,” Gedney said.

Last June’s visit did result in eight citations, which Gedney said was out of roughly 500 criteria the facility needs to meet. For comparison, Cody Regional Health received 12 citations and New Horizons in Lovell received 15, according to Medicare data.

“We are the most highly regulated industry out there,” Ostermiller said, calling Powell’s last two surveys “very positive.”

Some of the citations issued last June were minor. For example, one said that, while the results of past inspections were available at the front counter, Powell Valley Care Center staff should have also posted a notice saying the reports were available.

Another citation related to an incident in which an unknown care center staffer apparently took five residents’ pain-killing medications, known as opioids, and replaced them with a similar-looking medication used to treat hypertension. Ostermiller said an internal investigation at the care center last May “did not lead us to identify the employee involved.”

Medicare inspectors found that no one had been harmed, and that center administrators had conducted a “thorough” internal investigation, but said the incident should also have been reported to local law enforcement or other authorities.

“Law enforcement was later involved and have been conducting their own investigation,” Ostermiller said.

In another of the citations, Medicare inspectors found that seven out of 15 residents they surveyed were not getting enough baths or showers. That problem was attributed to a lack of certified nursing assistants (CNA).

A shortage of CNAs has also limited how many residents the Powell Valley Care Center has been able to hold; a couple months ago, the center was home to only 76 people — the lowest figure in decades — despite a continuing need for beds. That was due in part to 10 vacant CNA positions.

“We have tried very hard not to have a full house and [then] not being able to provide quality care,” Ostermiller said.

Increasing residents

Powell Valley Healthcare recently launched a new recruitment program designed to boost CNA retention for the long-term: The organization will pay for the nursing assistants’ training and certification in exchange for them agreeing to stay on the job for at least one year.

“We had people in the community that were interested in the CNA program and all of that, but they couldn’t afford to quit their job and not have income while they were going through the CNA class,” Gedney explained. He added that retaining certified nursing assistants is a problem for health care providers across the country.

Eight new CNAs are set to start training — taught by fellow PVHC employees — in April.

“We’re really excited,” Gedney said.

“There’s no shortage of elderly people needing our services and we want to be able to put things in place,” Ostermiller added.

If those eight CNA vacancies are filled, the Powell Valley Care Center would have a large enough staff to care for around 90 residents — up from the current 82, she said.

The care center has 100 certified beds — and has been completely full in the past —  but that “was actually too much,” Gedney said.

Nursing homes still carry a stigma of being places where residents are kept on strict schedules and told what to do, but the reality is “so much different now, I think,” Ostermiller said.

From choosing what time they want to wake up or eat to picking their own furniture and activities, “they [residents] drive their care,” Ostermiller said.

Medicare recently revised its nursing home regulations for the first times in decades, aiming to create rules that are more centered around nursing home residents. That will change the way the star ratings are calculated in the future.

Overall, Gedney and Ostermiller think the changes were needed and will be a positive thing.

The Powell Valley Care Center plans to host an open house soon to recognize the recent five-star rating from Medicare.

Ostermiller said the care center always has room for improvement, but “I think you do have to celebrate the positive.”

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